Two options for medical coverage are available (Plan Comparison). Both are provided through Wellmark Blue Cross and Blue Shield.
The ISU PPO Plan is a managed care plan that gives you a choice each time you need health care to access a Blue Cross/Blue Shield Preferred Provider or to use any provider. If you access a Blue Cross/Blue Shield Preferred Provider the plan pays a higher benefit. If you use out-of-network providers, benefits are generally payable, but at a lower level. This plan is often selected by individuals and their families who are comfortable selecting a Blue Cross/Blue Shield Preferred Provider and still wish to have coverage when unable to access a Blue Cross/Blue Shield Preferred Provider.
- Wellmark BluePPO plan is part of the Preferred Provider Organization, a national network of participating medical service providers. Use IZU as the prefix when looking at https://www.wellmark.com/finder.
- In-Network: no deductible, $25 office co-payment (does not apply to out-of-pocket maximum) and/or 10% co-insurance, coverage of routine services (annual physical exams and any related lab tests, hearing and eye exams).
- Out-of-Network: $400 single/$800 spouse/partner/child/family contract deductible, 20% co-insurance, no coverage for routine services.
- Out-of-pocket maximum (in-network) of $2,000 per single contract and $4,000 per spouse/partner, child or family contract on eligible medical expenses.
- Out-of-pocket maximum (out-of-network) of $4,000 per single contract and $8,000 per spouse/partner, child or family contract on eligible medical expenses.
- $125 emergency room co-payment (waived if admitted).
- Self-referral allowed.
Wellmark BluePPO Summary of Benefits & Coverage
Wellmark BluePPO Coverage Manual
The ISU HMO Plan is a managed care plan that requires use of the Wellmark Health Plan of Iowa (WHPI) network. Most services are paid at 100%. You pay the full cost of any care you receive outside the network except for emergency care when you are traveling out of the service area. This plan is often selected by individuals and their families whose needs can be satisfied by physicians within a specific network.
- This plan design has a network of participating physicians based in Iowa. This network has a medical service provider presence in every county in Iowa and in the contiguous counties that border Iowa. Current network participation is 99% of hospitals (acute care), 93% of primary care physicians (includes pediatricians), 91% of OB/GYN providers and 93% for specialists.
- Each member in the contract is required to designate a primary care physician (PCP). Female participants may elect to also designate a primary OB/GYN physician for their yearly exams. It is recommended that you verify your primary care physician is participating with the WHPI network, and locate the provider code (called the enrollment ID on Wellmark's site) when you choose to participate in the Wellmark BlueHMO. Use XQW as the prefix when looking at https://www.wellmark.com/finder.
- Services directed by your PCP: $15 co-pay for office calls – preventative, outpatient mental health/chemical dependency, $15 co-pay for in-network chiropractic care and acupuncture services, $0 deductible and $0 co-insurance.
- $125 emergency room co-payment (waived if admitted).
- In-Network Specialists: you may see a provider in the Network without a referral from PCP.
- Out-of-Network Specialists: If you require services that are not available from a specialist within the Network, Wellmark must approve out-of-Network referrals before you receive services or the services will not be covered.
- Referrals are not required for chiropractor visits, hearing exams, vision exams or acupuncture.
- Guest membership: An added benefit while away from home for 90 or more consecutive days. A guest membership provides access to Blue Cross and Blue Shield participating hospitals, physicians and other health care providers from which you can receive covered services. A guest membership is a valuable service for: long-term, out-of-state travelers (away from home up to 180 days); dependent children who attend college, out of state; and family members who reside in another state but are covered under this health plan. For more information or to arrange the guest membership, contact Wellmark customer service at 1-800-494-4478.
Wellmark BlueHMO Summary of Benefits & Coverage
Wellmark BlueHMO Coverage Manual
|Tier of Coverage||BluePPO||BlueHMO|
|Yourself + Spouse/Partner||$298.00||$152.00|
|Yourself + Children||$221.00||$100.00|
|Yourself + Family||$382.00||$193.00|
|Family Double Spouse (contract holder pays)||$270.00||$129.00|
With Doctor on Demand, you and your family members can speak with a board-certified doctor who can treat the most common medical conditions and prescribe medication if needed1. Using Doctor on Demand is easy and available 24 hours a day, 7 days a week, 365 days a year. You’ll love the convenience, and your Wellmark benefits apply automatically for you and your covered family members. Review Wellmark's Virtual Visit FAQ.
Get treatment for:
- Cold and flu
- Bronchitis and sinus infections
- Urinary tract infections
- Sore throats
- Pink eye
- Skin condition
- Mental health2
1 Doctor On Demand physicians do not prescribe Drug Enforcement Administration-controlled substances, and may elect not to treat or prescribe other medications based on what is clinically appropriate.
2 Includes treatment for certain psychological conditions, emotional issues and chemical dependency. Services performed by psychologists are covered. Psychiatry, which may include the use of prescription drugs, is not covered. For more information, call Wellmark at the number on your ID card.
Getting started is easy.
- Download the Doctor on Demand app or visit DoctorOnDemand.com.
- Have your Wellmark member ID card ready. You’ll be asked to enter your full Wellmark ID number, including the three character prefix.
- Create an account or sign in.
So, the next time you have a sore throat or the little one’s running a fever, pick up your smartphone and connect virtually with Doctor on Demand, any time, day or night.